What You Need to Know About Working As a Nurse in the UK (if You’re American)

what you need to know about working as a nurse in the UK
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If you’re an American nurse reading this and wanting to move abroad, you’re in luck!  I moved to London from the US to work as a nurse and I’m going to tell you exactly how I did it.  And while there are many different opportunities to work abroad (read about working in Saudi Arabia here), this post solely focuses on my personal experience as an American nurse working in London.

It’s also important to note that when referring to the “UK”, I’m strictly speaking about my experience in London.


This post was written by Melissa from Meliss Meets World


How to Work As a Nurse in the UK (If You’re an American Trained Nurse)



If you’re moving to London, don’t miss:  A Complete Guide to Visiting London


How Much Experience Do You Need to Work in the UK?

As far as how much experience you need to work in the UK, the answer varies.  If you’re looking to work in a more “specialized” area, you will need experience in that specific area (i.e. ER, NICU, etc), you cannot just come to work in the UK with no knowledge of the unit you’re going into.  I work in the emergency department and most of the nurses that I work with have prior experience working in emergency in some capacity.

I personally think that it’s best to have at least a few years of experience under you belt before coming to work in the UK (although this is not a hard and fast rule).  It would also be beneficial to have previous travel nurse experience so that you’re able to adapt and learn in a new environment fairly quickly without feeling intimidated.  But again, you do not need to be a travel nurse before coming to work in the UK.

You should be aware that one of the downsides to working in the UK, is being able to adjust your expectations around what nursing is like (compared to how you may have practiced as a nurse in the US).  There can be a big difference in practice between the two countries and I can’t decide if it’s harder having many years of experience in the US before coming over; or coming over without as much experience.


What Agency Should You Work With to Get a Job in the UK?

After making the decision to move abroad, the first step was to start reaching out to agencies.  I reached out to many different agencies, but the only agency that got back to me fairly quickly was Kate Cowhig Recruitment.  They mainly recruit nurses for the NHS from all over the world, and there are only a few nurses that come from the US (which could be because of the salary, which is discussed later in this article).


Visa Requirements to Work in the UK

In regards to your visa, the main thing to know is that your WORK VISA and your UK NURSING LICENSE are two separate things.  And while understanding how to get your visa can be confusing, the most common way to obtain a visa is to obtain a “skilled worker visa”.  However, you can also obtain a “dependent” or “family” visa to work as a nurse in England.



In order to apply for a skilled worker visa you must have a certificate of sponsorship (COS).  A COS is a number that will be given to you by the company that has hired you and has agreed to sponsor you.  I recommend starting your application for your skilled worker visa on the UK Government website (it’s quite lengthy) and once you finally have your COS you can finish the application.  The reason your COS is important is because this number verifies that there is a company sponsoring you (for your skilled worker visa).
Tip:  Be upfront with your company that you need them to sponsor your visa.  Not every company will agree to visa sponsorship.



The good news is, if there’s a company that you want to work with but they don’t agree to sponsor your visa you can still work with that company and file a dependent or family visa.  However, this is only if you have a partner that is moving with you and that partner is being sponsored.

You should also know that a dependent visa is more expensive than a skilled worker visa, because you will be charged around £500/year for healthcare; you must also pay for at least three years because that is the term of the visa.  Additionally, you will need to pay an added £1,000 for the application fee.  If you’re planning to start working for the NHS, some trusts will partially reimburse licensure and visa expenses, but this is all dependent on who is sponsoring your visa.


Working in the Public Sector vs Private Sector

Another thing to mention about working in the UK, is that there’s a big difference between private and public healthcare.  You might be familiar with the “NHS” (National Health Service), which is the public health system in England.  If you’re working with a company that sponsors your visa, you will almost certainly be working for the NHS.  Of course, working in the public sector has its pros and cons; but it’s usually easiest to move to the UK in order to work for the NHS and then switch to the private sector from there.  Additionally, many private healthcare jobs encourage nurses to have about six months of experience with the NHS.

If you want to work for a private healthcare company, (which is harder to do because of sponsorship reasons), then you’ll have many more job opportunities.  Working for a private company also allows you to work as a “bank” nurse, which is similar to being an “agency nurse” in the US.  Plus, you’ll earn quite a bit more money this way.


Obtaining Your Nursing License

As I touched on earlier, the visa process and the nurse license process are completely separate from one another.  The Nursing and Midwifery Council (NMC) oversees and regulates each nurses ability to maintain their license and practice in the UK.



The first step in getting your nursing license is to obtain your NMC pin.  The online application is pretty straightforward, and details all of the personal information you will need to submit and exams you will need to take.



The first exam you’ll take is the CBT – a two part, computer based test that tests your knowledge in nursing.  Part A focuses on medical calculations (you have 30 minutes to complete), and part B focuses on clinical knowledge (you have 2.5 hours to complete).  You can find helpful study materials and online practice tests before sitting for the CBT.  I took my CBT while I was still in the United States, as it is a requirement on the application process before being approved to be scheduled for your next exam, the OSCE.



The OSCE is an in person exam, testing your clinical and communication skills.  You can only take this exam once you’re in the UK.  The NHS will hire nurses before their OSCE is complete, and train you for the OSCE.  In order to do this, your visa application must be completed and approved because you will need the visa stamp in your passport before arriving to the UK and sitting for the OSCE.  If you do it this way, you will start as a nursing assistant because you can’t be a nurse until you officially have your license.  In my experience, I was very grateful to start as a nursing assistant because the culture shock and learning new systems was already overwhelming enough without having responsibilities of being a nurse.  While I could write an entire blog post on this and how to pass, my biggest advice is to take an in-person prep class.
If you’re hired with the NHS most “trusts”, or the NHS location you’ll be assigned to, will offer you a prep course.  If you’re offered a course, make sure this includes an in person mock exam as this is by far the most helpful exam to ensure passing.  (Read more about the OSCE here).
Once you’ve passed your OSCE and have obtained your pin or licensure, you can start working as a nurse and passing medications.


What to Expect Once You’ve Gotten Your Nursing License and You’re Working As a Nurse in the UK

Working as a nurse in the UK is very different than my experience working as nurse in the US.  Not only was the lack of orientation a big difference, but in my opinion, the biggest difference is the scope of nursing.  In my 12 years as a nurse, I’ve worked in the emergency department, interventional radiology, and neuroradiology.  At each job I had an extreme amount of responsibility and autonomy in my practice, which gave me a sense of fulfillment in my nursing career.  Once I moved to England, it seems that the nurses are much more task oriented and there isn’t as much emphasis placed on critical thinking.  When the floor is busy, it’s the doctors that do the in-depth assessments, start IVs, and draw blood (if there isn’t a nurse or tech who is available to do it).  The nurses are responsible to complete tasks such as administering medications, taking patients to radiology, moving patients around the department, etc.  It is important to note that for the most part, the physicians I’ve worked with have been wonderful!  The physicians in the UK are more hands and willing to help versus the physicians in the United States.  (While this is a generalization, this is just my perception and experience).


What You Can Expect to Be Paid Working As a Nurse in England

If you’ve done any research about nursing abroad, you will know that the nursing salaries in countries outside of the US are significantly less.  The salary I started with at the NHS is still less than what I made as a new grad nurse 12 years ago.  However, even though London has a high cost of living; our rent was cheaper than what we were paying when we lived in Boston.  We don’t have – or need a car – and groceries are much cheaper than in the US.  All of that helps with the salary being lower.

When talking about pay (in regards to working for the NHS, not private healthcare), you are paid based on your experience and these tiers are known as “bands”.  There are 9 bands – with band 1 being the least experienced and band 8b being the most experienced.  According to Medgen Healthcare Recruitment, the rankings are as follows:

  • Band 1 – Nursery Assistant
  • Band 2 – Healthcare Assistant
  • Band 3 – Emergency Care Assistant
  • Band 4 – Theatre Support Work
  • Band 5 – Newly Qualified Nurse
  • Band 6 – Nursing Specialist or Senior Nurse
  • Band 7 – Advanced Nurse/Nurse Practitioner
  • Band 8a – Modern Matron or Chief Nurse (advanced knowledge through study and practical experience over a wide range of work procedures and practices)
  • Band 8b –  Modern Matron or Chief Nurse (specialist knowledge covering more than one discipline acquired through extensive experience)

Starting out in the NHS as a band 5 level nurse (this means you’ve already passed your OSCE exam and you’re fully licensed as a nurse), you can expect to make about £32,000-£36,000/year.  However, before your OSCE exam, when you’re working as a nursing assistant, you will be at a band 4 pay grade which around £27,000/year.

Tip:  When you’re ready to sign your contract, make sure that you double check your salary amount.  Mine was wrong and needed to be fixed.  Also, once you’ve received your pin and your band is changed from 4 to 5, your pay change may not happen until months later, which should not be the case.

If you’re able to live and work off of a different visa like a dependant visa, this will give you options in regards to your job placement and salary, hence being able to work in the private sector and not workin for the NHS.

As I mentioned previously, another way to make more money is to work as a “bank nurse”, which is essentially an agency nurse.


If you’re an American nurse interested in working in the UK, I hope that this helps you get started.  If you have any questions, let me know in the comments below!  Or, connect with Melissa on Instagram!


If you’re interested in pursuing international nursing, make sure to check out these posts:

Different Ways to Pursue International Nursing

Getting a Nursing Job in Saudi Arabia with Helen Ziegler


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Kylee is a Neonatal Intensive Care (NICU) nurse passionate about making travel affordable and accessible to nurses. Inspiring nurses to travel both near and far, Kylee began Passports and Preemies in 2017 while volunteering in Skopje, North Macedonia as a way to reach nurses and advocate for the prevention of nurse burnout by traveling. Kylee is the original creator of the “8 Day Vacay” – a vacation geared towards nurses who aim to take advantage of the potentially 8 days off between work weeks with no need to use PTO.

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